CarePrice

Star Valley Health

, Afton

ProcedureCodeCash Price
IM ADMIN EACH ADDL COMPONENT90461< $1
SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2) (CORONAVIRUS DISEASE [COVID-19]) VACCINE, MRNA-LNP, SPIKE PROTEIN, BIVALENT, PRESERVATIVE FREE, 50 MCG/0.5 ML DOSAGE, FOR INTRAMUSCULAR USE91313< $1
Inj, vancomycin hcl (xellia)J3372< $1
METHYLPREDNISOLONE 4 MG TABLETJ7509< $1
IOTHALAMATE MEGLUMINE 17.2 % URETHRAL SOLUTIONQ9958< $1
PREDNISONE 5 MG TABLETJ7512< $1
SWALLOW CURRENT 0%G8996< $1
LIDOCAINE IN D5W 4 MG/ML INFUSION PREMIX (FOR PAIN)J2001< $1
PROPOFOL 10 MG/ML INTRAVENOUS EMULSIONJ2704< $1
PREDNISOLN 5MG 15MG 5ML SUJ7510< $1
ALBUTEROL INHALATION SOLUTIONJ7613$1.10
HYDROMORPHONE IN NS (STANDARD) PCA INFUSION 10 MG/50 ML (0.2 MG/ML)J1170$1.40
IPRATROPIUM BROMIDE COMPJ7645$1.40
LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATIONJ7614$1.49
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)J8540$2.23
ONDANSETRON 8MG TABQ0162$2.39
ACETYLCYSTEINE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER GRAMJ7608$2.43
HYDROXYPROGESTERONE CAPROATEJ1725$2.80
DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTIONQ9963$2.83
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [43069]J7605$3.27
GADOTERIDOL 1ML 5MMOL 10ML SNIJA9579$3.50
IOHEXOL 180MG 1ML 3.6GM 20ML SNIJQ9965$3.50
SODIUM CHLORIDE 0.9 % FOR NEBULIZATIONJ7699$4.90
NORMAL SALINE INFUSION 500 MLJ7040$5.27
NORMAL SALINE SOLUTION 1000CCJ7030$5.28
INJECT DEXAMETHASONE ACETATEJ1094$5.60
FINGER SPLINT, STATICQ4049$5.60
HEALTH BEHAVIOR INTERVENTION, GROUP (2 OR MORE PATIENTS), FACE-TO-FACE; EACH ADDITIONAL 15 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY SERVICE)96165$7.79
HUMAN PROTHROMBIN CMPLX CONCENTRATE (PCC)-LANS 1,000 UNIT IV SOLUTION [183437]C9159$8.27
HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTIONJ3410$8.40
BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MGJ7626$9.48
CRYO DESTRUCT LESION 2-1417003$9.77
LACTATED RINGERS INTRAVENOUS SOLUTIONJ7120$9.80
NALBUPHINE 10 MG/ML INJECTION SOLUTIONJ2300$9.80
RT PULSE OXI SINGLE CHECK94760$9.80
METHYLPREDNISOLONE 20 MG INJJ1020$10.50
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTIONJ7060$10.53
CIPROFLOXACIN LACTATE/D5W400MG/0.2L IVJ0744$10.54
METRONIDAZOLE IN NS IV SYRINGE 5 MG/ML (NICU/PEDS)J1836$10.57
LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACKJ1956$10.61
DOPAMINE 800 MG/250 ML (3 200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLNJ1265$10.68
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IVJ3480$10.68
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACKJ1450$10.75
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUSJ2305$10.75
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACKJ2020$10.80
LIDOCAINE HCL 20MG/ML INJECTJ2003$10.90
INJ ONDANSETRON HYDROCHLORIDEJ2405$10.96
IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTIONQ9967$11
PT INFRARED 1UNIT97026$11.10
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION [20339]J7799$11.13
PERCUT ALLERGY SKIN TESTS95004$11.20
TOPICAL FLUORIDE VARNISH99188$11.20
CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACKJ0737$11.23
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACKJ0736$11.23
FUROSEMIDE 10 MG/ML INJECTION SOLUTIONJ1940$11.48
DOBUTAMINE 12.5 MG/ML IV SOLUTION (MCG)J1250$11.50
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SYRINGEJ3475$11.64
ESMOLOL 2 000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IVJ1805$11.73
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGEJ1920$11.77
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTIONJ9060$11.79
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTIONJ2795$11.98
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTIONJ2765$12.03
FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTIONJ9190$12.06
AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE ISO-OSMOTIC IVJ0282$12.37
FENTANYL INFUSION 2500 MCG/50 MLJ3010$12.55
IMMUNIZATION ADMIN ORAL ADD'L90474$12.60
ADMIN INFLUENZA VIRUS VACCINEG0008$12.60
ADMIN HEPATITIS B VACCINEG0010$12.60
IMMUNIZATION ADMIN ORAL90473$12.60
MIDAZOLAM (PF) 5 MG/ML NASALJ2250$12.62
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTIONJ1630$12.96
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTIONJ9045$13.21
DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTIONJ9000$13.25
METHYL PRED SS 40MG JJ2920$13.30
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTIONJ9263$13.30
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTIONJ3415$13.30
METHYLPRED SS 1G JJ2930$13.30
MONOSUSPENSION ARM/HAND SUPPL3969$13.30
METHYLPRED LA 40MG JJ1030$13.30
HYDROGEL DRESSING, WOUND FILLER, GEL, PER FLUID OUNCEA6248$13.30
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTIONJ0133$13.44
INJECTION LORAZEPAMJ2060$13.88
IPRATROPIUM .02% .5MG/2.5J7620$14
SEDIMENTATION RATE ERYTHOCYTE85651$14
BICILL CR 1,200,000J0558$14
GO HAND FINGER ORTHOSIS ONE OR MORE JOINT CUSTOML3929$14
CYTARABINE 100MG 2GM 20ML SNIJJ9100$14.05
LEVETIRACETAM 1 000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACKJ1953$14.40
ANTIHEMOPHILIC FACTOR-VWF 1 000 UNIT-2 400 UNIT INTRAVENOUS SOLUTIONJ7187$14.64
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTIONJ3490$14.70
HAEMOPH B VAC 0.5ML J90645$14.70
METHOCARBAMOL 100 MG/ML INJECTION SOLUTIONJ2800$15.12
INJ DEXAMETHASONE SOD PHOSPHJ1100$15.13
IM ADMIN 1ST/ONLY COMPONENT90460$15.20
ZOLEDRONIC ACID 5MG/100MLJ3489$15.20
GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS SOLUTIONJ9201$15.32
HB THIOPURINE S-METHYLTRANSFERASE (TPMT) SENDOUT84433$15.40
AMINOPHYLLN LESS THAN250MG 250MG 10ML SNIVJ0280$15.59
PACLITAXEL 1MG 30MG 5ML CN MDVJ9267$15.96
GAUZE <=16 IN NO W/SAL W/O BA6222$16.10